Primary plasmacytomas of the colon

Primary plasmacytomas of the colon are very rare. Six documented cases have been reported, and this article reports the seventh case. Plasmacytomas should be included in the differential diagnosis of a solitary tumor of the colon. They have a better prognosis than carcinomas and secondary plasmacytomas. Address reprint requests to Dr. Campos: Ferguson-Droste-Ferguson Hospital, 72 Sheldon Boulevard, S. E. Grand Rapids, Michigan 49503.     

Priapism resulting from fluphenazine hydrochloride treatment reversed by diphenhydramine

A chronic schizophrenic patient received 30 mg fluphenazine hydrochloride (Prolixin) PO and developed priapism. Urological examination and subsequent urological workup was negative, indentifying fluphenazine hydrochloride as the cause of the priapism. During the period of priapism evaluation, the patient developed a severe extrapyramidal reaction that was treated with diphenhydramine (Benadryl) 50 mg IV push. There was remission of the extrapyramidal reaction in three minutes followed by resolution of the priapism. The rationale for the treatment of antipsychotic drug-induced priapism with anticholinergic drugs is discussed.     

Severe exposure hypothermia: a resuscitation protocol

Although hypothermia has been described as an emergency in suspended animation, severe degrees of hypothermia mandate appropriate aggressive intervention. Because of cardiac instability with core temperature below 28 C, aggressive invasive rewarming by F-F partial bypass is often ideal in this setting. In contrast, a gentle approach in other therapeutic maneuvers is equally important to prevent iatrogenic induction of VF in nonarrested victims. If the only definite criterion for diagnosis of death in hypothermia is failure to respond to resuscitation and rewarming, successful resuscitation must carefully balance aggressive and gentle interventions. Because CPR protocols involve legal as well as medical questions, additional prospective data are especially critical for resolving controversies in the initial management of profound exposure hypothermia.     

Endocrinology of shock

The development of shock initiates a cascade of responses in an effort to reestablish homeostasis. Three of the most important hormonal and neurohumoral changes are the secretion of glucocorticoids, catecholamines, and vasopressin. Regulation of adrenal function is much more complex than originally thought. Hemorrhage is a potent stimulus for cortisol release, and both ACTH and ACTH-independent mechanisms have been described. The ACTH response to its releasing hormone, corticotropin releasing hormone (CRF), is itself amplified by vasopressin, which appears to have intrinsic CRF properties. Because ACTH is synthesized as part of a large precursor molecule (pro-opiomelanocortin) containing the amino acid sequences for several important proteins, stimulation of ACTH release has far-ranging effects, the specifics of which are just being clarified. Norepinephrine and epinephrine levels increase manyfold above baseline within minutes of the onset of hemorrhagic shock. Only patients experiencing cardiac arrest or the rare patient with a very active pheochromocytoma have higher concentrations. The levels reached are far in excess of those required to cause both cardiovascular and metabolic alterations. Because of the presence of the endogenous opiates leucine and methionine enkephalin in the neurosecretory granule, it is very likely that the enkephalins are coreleased with the catecholamines, modifying their cardiovascular effects and producing analgesia. Hypovolemia is also a potent stimulus for vasopressin secretion, which overrides hypotonicity, presenting a clinical picture quite compatible with the syndrome of inappropriate antidiuretic hormone secretion, from which it must be differentiated. Vasopressin also is released by pain, nausea, and hypoxia, all of which are likely to be present in the patient with shock.(ABSTRACT TRUNCATED AT 250 WORDS)     

Aseptic knee effusion associated with calcified guinea worms

Reported is a case of aseptic knee effusion associated with the presence of a calcified guinea worm, Dracunculus medinensis, in close proximity to the joint. The patient, a native of Nigeria, presented with chronic right knee pain and swelling. He did well with symptomatic treatment including non-steroidal antiinflammatory drugs, rest, ice, and elevation of the leg. Dracunculiasis is prevalent in parts of Asia and Africa, but has been described only rarely in the United States.     

Subacute sequelae of carbon monoxide poisoning

From January 1980 to August 1983, 213 patients with carbon monoxide poisoning were seen; 131 received hyperbaric oxygen and had no sequelae. Eighty-two patients were treated with normobaric oxygen; ten (12.1%) returned with clinically significant sequelae. The specific neurological sequelae included headaches, irritability, personality changes, confusion, and loss of memory. This recurrent symptomatology developed within one to 21 days (mean, 5.7 days) after the initial exposure, although no reexposure occurred. These recurring symptoms resolved rapidly with hyperbaric oxygen therapy. We recommend that hyperbaric oxygen therapy be used whenever CO poisoning symptoms recur.     

Cardiovascular effects of toxic concentrations of theophylline in the dog

A canine model of theophylline toxicity was used to study the cardiovascular effects seen in severe theophylline poisoning. Eight mongrel dogs were divided equally into two groups. The dogs were anesthetized with pentobarbital and paralyzed with pancuronium bromide. They were ventilated with 100% oxygen and underwent the placement of pulmonary arterial, central venous, femoral arterial, and peripheral venous lines. Group 1 animals received 5.6 mL/kg D5W intravenously (IV) over 20 minutes. Group 2 animals received 140 mg/kg (5.6 mL/kg) of aminophylline IV over the same period. Peak theophylline levels in Group 2 animals averaged 208.9 micrograms/mL. Group 2 animals suffered a marked fall in mean arterial pressure (MAP) and an increase in heart rate. In spite of the fall in MAP (P less than .01), cardiac index actually was increased almost two-fold over Group 1 animals, due mainly to a fall in systemic vascular resistance index (P less than .01). There were no physiologically significant differences in ventricular filling pressures or stroke index between the two groups.     

A hypochlorite solution for removing bacteria from CPR manikins

To study the effectiveness of a dilute hypochlorite solution in removing bacteria from cardiopulmonary resuscitation (CPR) manikins, cultures from several areas of manikins disinfected with hypochlorite were compared with those from manikins disinfected with another protocol, and bacteria which grew were counted and identified. The use of dilute hypochlorite resulted in significant reduction of bacterial numbers (P less than .0005), without damaging manikin components or provoking unpleasant reaction from trainees. Dilute hypochlorite disinfection of CPR training manikins after each class session might greatly reduce the possibility of transmitting pathogenic bacteria or other microorganisms between participants in resuscitation practice.     

The effect of carbonated beverages on ipecac-induced emesis

To determine the effect of carbonated beverages on syrup of ipecac, 24 pediatric patients were randomly administered six ounces of water or a carbonated beverage with syrup of ipecac. Changes in the abdominal girth, the volume of emesis, and time of emesis were monitored in all patients. In the carbonated beverage group a significant difference (P less than 0.05) was observed between the baseline and 10-min post-ipecac administration abdominal girth measurements. The time of emesis and volume of emesis were not significantly different in the water or carbonated beverage groups. We conclude that carbonated beverage administration does not alter the effectiveness of syrup of ipecac.     

EUS spectrum analysis for in vivo characterization of pancreatic and lymph node tissue: a pilot study

BACKGROUND: EUS is limited by variability in the examiner's subjective interpretation of B-scan images to differentiate among normal, inflammatory, and malignant tissue. By using information otherwise discarded by conventional EUS systems, quantitative spectral analysis of the raw radiofrequency (RF) signals underlying EUS images enables tissue to be characterized more objectively. OBJECTIVE: Our purpose was to determine the feasibility of using spectral analysis of EUS data for characterization of pancreatic tissue and lymph nodes. DESIGN AND SETTING: A pilot study of eligible patients was conducted to analyze the RF data obtained during EUS by using spectral parameters. PATIENTS: Twenty-one subjects who underwent EUS of the esophagus, stomach, pancreas, and surrounding intra-abdominal and mediastinal lymph nodes. MAIN OUTCOME MEASUREMENTS: Linear regression parameters of calibrated power spectra of the RF signals were tested to differentiate normal pancreas from chronic pancreatitis and from pancreatic cancer as well as benign from malignant-appearing lymph nodes. RESULTS: The mean intercept, slope, and midband fit of the spectra differed significantly among normal pancreas, adenocarcinoma, and chronic pancreatitis when all were compared with each other (P < .01). On direct comparison, mean midband fit for adenocarcinoma differed significantly from that for chronic pancreatitis (P < .05). For lymph nodes, mean midband fit and intercept differed significantly between benign- and malignant-appearing lymph nodes (P < .01 and P < .05, respectively). LIMITATIONS: Small sample population and spatial averaging inherent to this technique. CONCLUSIONS: Mean spectral parameters in EUS imaging can provide a noninvasive method to discriminate normal from diseased pancreas and lymph nodes.     

Associations of sense of coherence with psychological distress and quality of life in inflammatory bowel disease

AIM: To investigate the relationship between sense of coherence, psychological distress and health related quality of life in inflammatory bowel disease (IBD).METHODS: This cross-sectional study enrolled a consecutive sample of 147 IBD (aged 45.1 ± 14.1 years; 57.1% female) patients recruited from a tertiary gastroenterology service. Sixty-four participants met diagnostic criteria for Crohn’s disease, while eighty-three patients had ulcerative colitis. Socio-demographic data (education, age, race, gender, gross monthly income and marital status), disease-related variables (illness activity, relapse rate in past 2 years, history of surgery and time since diagnosis), sense of coherence (Antonovsky’s SOC scale), psychological distress symptoms (Hospital Anxiety and Depression Scale) and health-related quality of life (HRQoL; WHOQOL-Bref) were assessed. Hierarchical multiple regression analyses were performed to identify factors that are independently associated with psychological distress and HRQoL in patients with IBD and to provide indications for possible moderating or mediating effects. In addition, formal moderation and mediation analyses (Sobel tests) were performed to confirm potential moderators/mediators of the relationship between SOC, psychological distress symptoms and HRQoL.RESULTS: Lower SOC scores (std beta= -0.504; P < 0.001), female gender (std beta = 0.176; P = 0.021) and White race (std beta = 0.164; P = 0.033) were independently associated with higher levels of depressive symptoms, while lower levels of SOC (std beta = -0.438; P < 0.001) and higher relapse rate (std beta = 0.161; P = 0.033) were independently associated with more severe anxiety symptoms. A significant interaction between time since diagnosis and SOC was found with regard to the severity of depressive or anxiety symptoms, as the interaction term (time since diagnosis X SOC) had beta coefficients of -0.191 (P = 0.009) and -0.172 (P = 0.026), respectively. Lower levels of anxiety symptoms (std beta = -0.369; P < 0.001), higher levels of SOC (std beta = 0.231; P = 0.016) and non-White race (std beta = -0.229; P = 0.006), i.e., mixed-race, which represented the reference category, were independently associated with higher levels of overall HRQoL. Anxiety symptoms were the most potent independent correlate of most aspects of HRQoL. In addition, anxiety mediated the association between SOC and satisfaction with health, as well as its relationship with physical, mental, and social relations HRQoL. Depressive symptoms also mediated the association between SOC and mental HRQoL.CONCLUSION: Our data indicated that SOC is an important construct, as it influences psychological distress and has significant albeit indirect effects on several HRQoL domains in IBD.     

Are urine dipsticks reliable indicators of hematuria in blunt trauma patients?

Dipstick results in patients with blunt trauma have not been demonstrated to be predictive of the amount of microscopic hematuria. Our study examined the relationship between dipstick results and the degree of microscopic hematuria in 185 patients admitted to our emergency department following blunt trauma. Urine samples of 169 were dipsticked; the remaining 16 were grossly bloody. A wide range of microscopic hematuria results was obtained for each dipstick value. Of the 80 patients with negative dipsticks, 15 (18.7%) actually had microscopic hematuria. Conversely in 16 of 32 patients (50%) with a "trace" positive dipstick value, no microscopic hematuria was present. Similarly the dipstick value of 1+ had three of 14 (21%) false positives. False positives were recorded seven of 26 times (27%) for 2+, and three of 17 times (18%) for 3+ dipstick readings. We conclude that dipstick results do not correlate well with the presence or absence of hematuria in patients with blunt trauma. Microscopic urinalysis is a better test on which to base the decision to perform further diagnostic tests in the evaluation of the urinary tract.     

Subsets associated with developing acute pancreatitis in patients with severe hypertriglyceridemia and the severity of pancreatitis

Background and objectivesHypertriglyceridemia (HTG) is a rare but well-recognized cause for acute pancreatitis (AP). This study aimed to determine subsets related to development of AP in patients with severe HTG and the severity of HTG-induced AP (HTG-AP).MethodsPatients who had severe HTG (serum triglyceride level >1,000 mg/dL) more than once between Jan. 2010 and Dec. 2017 in a single institute were evaluated retrospectively. Patients were divided into two groups, with AP or without AP, and were compared. HTG-APs in patients with severe HTG were compared to APs due to other causes during the same period.ResultsSixty-three patients (19.3%) presented with AP of a total 326 patients with severe HTG. The AP group displayed younger age, more alcohol consumption and diabetes mellitus, and higher initial/maximum serum levels of triglyceride, glucose, HbA1c, total cholesterol, and calculated non-high-density lipoprotein cholesterol (p < 0.05). HTG-APs were clinically more severe compared with 277 APs due to other causes in terms of CRP (p < 0.001), CT severity index (p = 0.002), revised Atlanta classification (p < 0.001), and hospital stay (p = 0.011). In logistic regression analysis, maximum serum triglyceride level (OR 2.706, p = 0.015), alcohol consumption amount (OR 5.292, p < 0.001), and age (OR 0.358, p = 0.017) were independently associated with development of AP in patients with severe HTG.ConclusionsDevelopment of AP in patient with severe HTG was independently associated with younger age, higher serum TG level, and more alcohol consumption. HTG-APs are clinically more severe than APs due to other causes.